We offer a comprehensive approach to the diagnosis and management of food allergies. We utilize all resources available to ensure an accurate diagnosis, which is essential for successful long-term management. Our treatment plans are individualized based on patient and family needs.
- A detailed and thorough clinical history by locally recognized, board-certified allergists with specialty training in food allergies.
- Allergy skin testing
- Allergy blood testing
- In-office oral food challenges
- Development of an emergency action plan with step-by-step instructions for the treatment of allergic food reactions.
- Patient and parent education on avoidance measures and the use of epinephrine devices.
- Vaccines for the egg-allergic child.
- Collaboration and referral for nutritional evaluation by a licensed dietician.
What are Food Allergies?
Food allergies are an unnecessary response by the immune system in which allergy antibody (known as IgE) is produced against the offending food. With further exposures, the IgE reacts with cells in the body, triggering an allergic reaction. Most food reactions are obvious, with the onset of symptoms within minutes of exposure. Some food reactions may be delayed and begin several hours later, making the diagnosis more difficult. The reactions may range from the very mild (a facial rash and itchy mouth) to severe, life-threatening anaphylaxis. Severe food reactions may be fatal.
Signs and symptoms of an allergic food reaction include:
- Skin: hives, redness, swelling, facial rash
- Airway: tightness in the chest/throat, gagging, coughing, wheezing, shortness of breath
- Gastrointestinal: itchy tongue/mouth, vomiting, stomach pain
- Cardiovascular: fainting, lethargy, shock
- General: itchy palms/feet, feeling a sense of doom
It is true that food allergies are on the rise. In fact, peanut allergy has doubled in the past 10 years, and research has not been able to provide a single good explanation for this increase.
Food allergies vary based on age and geographic location. For instance, while peanut allergy is common in the United States, it is rare in China, where rice allergy is much more frequent.
Although allergies may occur to any of hundreds of foods, more than 90 percent of food allergies are caused by only 10 foods. In children, the five most common food allergies are egg, milk, peanut, soy and wheat. Most children will outgrow egg and milk allergy, but peanut allergy tends to be lifelong. For adults, the common food allergies are shellfish, fin fish, tree nuts and peanuts. In some children, the initial sign of a food allergy may be a refusal to eat a common food such as egg or peanut. The parent may mistake this for a texture or preference issue but, in fact, this is a common way for a young, nonverbal child to display an allergy.
Food Intolerance refers to reactions to foods that are not caused by the IgE antibody. These reactions are not life-threatening but can still be very uncomfortable and problematic. Many people use the term food allergy for these reactions, which leads to lots of confusion. The most common food intolerance is gastrointestinal upset such as bloating, diarrhea, stomach pain and gas due to milk and lactose intolerance or wheat and gluten intolerance. In some cases, we know the mechanism of intolerance to foods:
- Milk/dairy-deficiency of digestive enzymes for lactose (milk sugar)
- Gluten-non allergic immune reaction to grain protein
Other food reactions, such as heartburn after eating spicy foods, gas after eating beans, headaches after drinking red wine or anxiousness after ingesting caffeine or chocolate are common and vary from person to person.
Allergy tests are not helpful for food intolerances, even when the reaction is severe. In addition to classic immediate food reactions, there are other conditions associated with food allergies for which allergy testing can be helpful:
- Food-Dependent, Exercise-Induced Anaphylaxis
- Oral Allergy Syndrome, which is itching limited to the mouth and throat after eating fresh fruits and vegetables
- Eosinophilic Esophagitis
- Atopic Dermatitis (eczema)
Though food reactions can affect health in many ways, IgE reactions are not felt to play a significant role in the following conditions, and food allergy testing is not indicated or helpful:
- Headaches, Migraines
- Fibromyalgia, Psoriasis
- Rheumatoid Arthritis
- Autism, ADD
- Lactose Intolerance
- Gluten Intolerance
- Bloating, Diarrhea, Stomach pain
- Irritable Bowel Syndrome
Oral Food Challenge Information
At times it may be difficult to know if a food allergen has been outgrown. As the blood test and skin tests for food allergies are not 100 percent accurate, the oral food challenge is a useful tool to see if a food can be safely ingested. Our doctors will discuss with you if a food challenge may be appropriate.
Food Allergy Research and Education, www.foodallergy.org
American Academy of Allergy, Asthma, and Immunology, www.aaaai.org
Kati Ohlmeyer, Registered Dietitian, http://www.straightforwardwellness.com/